Hideo Kojima in an interview with the French site Telerama said that Death Stranding is closely connected with the life experience of the Japanese developer. The game designer was inspired by depression and a feeling of loneliness when creating the game:
"Death Stranding features a delivery boy in a post-apocalyptic future. He must venture into desolation alone and reconnect a totally fractured society. But, as we progress in Death Stranding, we notice that there are actually several thousand of us playing the same game, through the structures and objects that we have all built and that remain in a common environment. You don’t see the faces or avatars of other players, but what they leave in this universe is intended to provide cohesion, a sense of calm in the face of the harshness of the Death Stranding world.
As a child, I felt – and still do feel a little today – loneliness and I struggled to express it to my friends. It was something that was not said, and I don’t think they would have really understood it. I felt like a weird person, a little like Travis Bickle in Taxi Driver. I identified myself in what the off-axis person in Scorsese’s film felt, and the fact that a guy in New York could be suffocated by the feelings I was experiencing myself helped me a lot. I realized that I was not sick, just linked to others through a kind of melancholic connection specific to the human condition."